MEDICARE: SHEALEEN OTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1841126000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEALEEN OTIS

Provider Business Mailing Address
First Line	:	1942 BEAVER PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-2525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E TUDOR RD UNIT 105
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7457
Country	:	US
Telephone Number	:	907-334-9001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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Directions to “ SHEALEEN OTIS ” Practice Location

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